Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/04—Anorexiants; Antiobesity agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/06—Antihyperlipidemics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
  • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics

Definitions

• the present invention refers to the use of compounds binding to the sigma receptor for the treatment of metabolic syndrome, especially hyperlipidemias, in particular hypertriglyceridemias and the prevention or the prophylaxis of the symptoms of metabolic syndrome, especially hyperlipidemias, in particular hypertriglyceridemias.
• the treatment of metabolic syndrome is of great importance in medicine.
• the metabolic syndrome is a widespread disease, particularly in the United States and Europe. Based on survey data from 1988 to 1994 and 2000 census data, the
• the main object of this invention is the use of a compound binding to the sigma receptor in the production of a medicament for the treatment of metabolic syndrome.
• Another preferred object of the invention is the use of at least one compound binding to the sigma receptor and having an IC 50 value of ⁇ 500 nM for the production of a medicament for the treatment of metabolic syndrome.
• the metabolic syndrome and definitions thereof are described in detail by Eckel et al., The Lancet, Vol. 365 (2005), 1415-1428, included herewith by reference.
• One of the respective definitions was established by the WHO in 1998 (as described in Alberti et al., Diabet. Med. 1998, 15, pages 539-53, the respective description thereof is herewith incorporated by reference and forms part of the present disclosure).
• the other, more widely accepted, definition of the metabolic syndrome was established by the Adult Treatment Panel (ATP III) of the US National Cholesterol Education Program (NCEP) in 2001 , as described in JAMA 2001 ; 285; 2486-97, the respective description thereof is herewith incorporated by reference and forms part of the present disclosure.
• the metabolic syndrome is characterized by an interaction of several physiological parameters such as triglycerides, lipids, blood pressure, glucose levels and insulin levels. Thus it includes especially hyperlipidemias and hypertriglyceridemia.
• Hypertriglyceridemia can be categorized by the Fredrickson classification of lipid disorders (Fredrickson, 1971 ; Beaumont et al., 1970). All hyperlipidemias (types I, Mb, III, IV and V) except type Ma are characterized by elevated triglyceride levels.
• Type I It is characterized by severe elevations in chylomicrons and elevated triglycerides. Because chylomicrons also contain a small amount of cholesterol, serum cholesterol levels also are quite high.
• Type lib It is the classic mixed hyperlipidemia (high cholesterol and triglycerides) caused by elevations in both low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL).
• Type III It is also known as dysbetalipoproteinemia, remnant removal disease, or broad-beta disease. Typically, these patients have elevated total cholesterol and triglyceride levels and are easily confused with patients with type Mb hyperlipidemia. Patients with type III hyperlipidemia have elevations in intermediate-density lipoprotein (IDL) 1 a VLDL remnant. • Type IV: It is characterized by abnormal elevations of VLDL and triglycerides. Serum cholesterol levels are normal. Type V: It is the combination of types I and IV (elevations of both chylomicrons and VLDL). Serum cholesterol levels always are elevated, but the LDL cholesterol levels are normal. Given the rarity of type I disease, when elevated triglycerides are noted, the most likely cause is type V hyperlipidemia.
• This/these compound/s may be in neutral form, the form of a base or acid, in the form of a salt, preferably a physiologically acceptable salt, in the form of a solvate or of a polymorph and/or in the form of in the form of its racemate, pure stereoisomers, especially enantiomers or diastereomers or in the form of mixtures of stereoisomers, especially enantiomers or diastereomers, in any suitable mixing ratio.
• treatment encompasses prevention, amelioration and/or complete recovery from the disease. Said term also includes the prevention, amelioration and/or complete recovery of one or more symptoms associated with the disease.
• the sigma receptor/s as used in this application is/are well known and defined using the following citation: This binding site represents a typical protein different from opioid, NMDA, dopaminergic, and other known neurotransmitter or hormone receptor families (G. Ronsisvalle et al. Pure Appl. Chem. 73, 1499-1509 (2001 )). Pharmacological data based on ligand binding studies, anatomical distribution and biochemical features distinguish at least two subtypes of ⁇ receptors ( R. Quiron et al., Trends Pharmacol. Sci. 13, 85-86 (1992); M.L.Leitner, Eur. J. Pharmacol. 259,
• Compound/s binding to the sigma receptor or "sigma ligand” as used in this application is/are defined as having an IC 50 value of ⁇ 5000 nM, more preferably ⁇ 1000 nM, more preferably ⁇ 500 nM. More preferably, the IC 50 value is ⁇ 250 nM. More preferably, the IC 50 value is ⁇ 100 nM. Most preferably, the IC 5O value is ⁇ 50 nM. Additionally, the wording "Compound/s binding to the sigma receptor", as used in the present application is defined as having at least >50% displacement using 10 mM radioligand specific for the sigma receptor (e.g. preferably 3 H- pentazocine) whereby the sigma receptor may be any sigma receptor subtype (sigma-1 or sigma-2). Preferably, said compounds bind to the sigma-1 receptor subtype.
• Compounds binding to the sigma receptor generally also known as sigma ligands are well known in the art with many of them falling under the definition for "Compound/s binding to the sigma receptor" set up above. Still even though there are many uses known for sigma ligands such as antipsychotic drugs, anxiolytics, antidepressants, the treatment of stroke, antiepileptic drugs and many other indications there is nowhere any mentioning of these compounds being useful against metabolic syndrome.
• Compounds binding to the sigma receptor known in the art and matching the criteria of sigma ligand i.e. having an IC 50 ⁇ 5000 nM
• these compounds may bind to the sigma-1 and/or the sigma-2 receptor.
• these compounds are in form of a salt, a base or an acid.
• the salts/bases/acids indicated in the list are to be understood as being exemplary and therefore may represent any salt, base or acid of the compound.
• the following list is based on the list immediately above and - being especially preferred - lists compounds binding to the sigma receptor known in the art and having an IC 50 ⁇ 500 nM.
• these compounds are in form of a salt, a base or an acid.
• the salts/bases/acids indicated in the list are to be understood as being exemplary and therefore may represent any salt, base or acid of the compound.
• the compounds of the invention are also meant to include compounds which differ only in the presence of one or more isotopically enriched atoms.
• compounds having the present structures except for the replacement of a hydrogen by a deuterium or tritium, or the replacement of a carbon by 13 C- or 14 C-enriched carbon or 15 N-enriched nitrogen are within the scope of this invention.
• a preferred embodiment of the invention includes the use of at least one compound binding to the sigma receptor for the production of a medicament for the treatment of elevated triglyceride levels. Also preferred is the use of at least one compound binding to the sigma receptor for the production of a medicament for treatment of chylomicronemia, hyperlipoproteinemia, hyperlipidemia (especially mixed hyperlipidemia), hypercholesterolemia, lipoprotein disorders and dysbetalipoproteinemia.
• An especially preferred embodiment is drawn to the use of at least one compound binding to the sigma receptor for the production of a medicament for the treatment hypertriglyceridemia including both the sporadic and familial disorder (inherited hypertriglyceridemia).
• a treatment reducing plasma levels of triglycerides for treating excess triglycerides in plasma does not necessarily include treatment of plasma cholesterol and glucose levels, that may be also concomitantly elevated (hypercholesterolemia and hyperglycemia, respectively) in metabolic syndrome.
• sigma-1 receptor ligands to produce a medicament for the treatment of hypertriglyceridemia includes also the treatment of different pathological conditions involving elevated triglyceride levels, such as chylomicronemia, hyperlipoproteinemia, mixed hyperlipidemia and dysbetalipoproteinemia.
• salt is to be understood as meaning any form of the active compound according to the invention in which this assumes an ionic form or is charged and is coupled with a counter-ion (a cation or anion) or is in solution.
• a counter-ion a cation or anion
• complexes of the active compound with other molecules and ions in particular complexes which are complexed via ionic interactions.
• physiologically acceptable salt is understood in particular, in the context of this invention, as salt (as defined above) formed either with a physiologically tolerated acid, that is to say salts of the particular active compound with inorganic or organic acids which are physiologically tolerated - especially if used on humans and/or mammals - or with at least one, preferably inorganic, cation which are physiologically tolerated - especially if used on humans and/or mammals.
• physiologically tolerated salts of particular acids are salts of: hydrochloric acid, hydrobromic acid, sulfuric acid, hydrobromide, monohydrobromide, monohydrochloride or hydrochloride, methiodide, methanesulfonic acid, formic acid, acetic acid, oxalic acid, succinic acid, malic acid, tartaric acid, mandelic acid, fumaric acid, lactic acid, citric acid, glutamic acid, hippuric acid picric acid and/or aspartic acid.
• physiologically tolerated salts of particular bases are salts of alkali metals and alkaline earth metals and with NH 4 .
• solvate is to be understood as meaning any form of the active compound according to the invention in which this compound has attached to it via non-covalent binding another molecule (most likely a polar solvent) especially including hydrates and alcoholates, e.g. methanolate.
• a polar solvent especially including hydrates and alcoholates, e.g. methanolate.
• the following proviso applies: with the proviso that the compounds orlistat, sibutramine, phentermine, diethylpropion, benzphetamine, phendimetrazine are excluded from the compounds to be used.
• the compound binding to the sigma receptor used is acting on the sigma receptor as an antagonist.
• the compound binding to the sigma receptor used is acting on the sigma receptor as an inverse agonist.
• the compound binding to the sigma receptor used is acting on the sigma receptor as a partial antagonist.
• the compound binding to the sigma receptor used is acting on the sigma receptor as an agonist.
• the compound binding to the sigma receptor used is acting on the sigma receptor as a mixed agonist/antagonist, a partial agonist or a partial antagonist.
• the sigma receptor to which the "compound binding to the sigma receptor” is binding to is the sigma-1 receptor.
• “Compound/s binding to the sigma receptor” as used in this application is/are defined as having an IC50 value ⁇ 500O nM, more preferably ⁇ 100O nM 1 more preferably ⁇ 500 nM. More preferably, the IC 50 value is ⁇ 250 nM. More preferably, the IC 50 value is ⁇ 100 nM. Most preferably, the IC 50 value is ⁇ 50 nM.
• Compound/s binding to the sigma receptor is defined as having at least ⁇ 50% displacement using 10 mM radioligand specific for the sigma receptor (e.g. preferably 3 H-pentazocine) whereby the sigma receptor may be any sigma receptor subtype.
• the compound binding to the sigma receptor as defined above, has an IC 50 value of ⁇ 1000 nM.
• the compound binding to the sigma receptor as defined above, has an IC 50 value of ⁇ 500 nM.
• the compound binding to the sigma receptor as defined above, has an IC 50 value of ⁇ 250 nM.
• the compound binding to the sigma receptor as defined above, has an IC 50 value of ⁇ 100 nM.
• the compound binding to the sigma receptor as defined above, has an IC 50 value of ⁇ 50 nM.
• “compounds highly specific for the sigma receptor” are defined as being “Compound/s binding to the sigma receptor”, as defined above, having an IC 50 value of ⁇ 10O nM.
• the compound binding to the sigma receptor as defined above is binding to the sigma-1 receptor subtype.
• the compound binding to the sigma receptor as defined above may bind to the sigma-2 receptor subtype.
• the dose administered can be quite low depending on the route of administration and is well known in the art because sigma compounds are known therapeutics.
• the daily dosage for humans and animals may vary depending on factors that have their basis in the respective species or other factors, such as age, sex, weight or degree of illness and so forth.
• the daily dosage for humans may preferably be in the range from 1 to 2000, preferably 1 to 1500, more preferably 1 to 1000 milligrams of active substance to be administered during one or several intakes per day.
• Any medicament according to the invention contains the active ingredient as well as optionally at least one auxiliary material and/or additive and/or optionally another active ingredient.
• the auxiliary material and/or additive can be specifically selected from conserving agents, emulsifiers and/or carriers for parenteral application.
• the selection of these auxiliary materials and/or additives and of the amounts to be used depends upon how the pharmaceutical composition is to be applied. Examples include here especially parenteral like intravenous subcutaneous or intramuscular application formulations but which could also be used for other administration routes.
• Routes of administration preferably include intramuscular injection, intraveneous injection, subcutaneous injection, sublingual, bucal, patch through skin, oral ingestion, implantable osmotic pump, collagen implants, aerosols or suppository.
• Included in this invention are especially also methods of treatments of a patient or a mammal, including men, suffering from metabolic syndrome using compounds binding to the sigma receptor.
• R 3 and R 4 are independently selected from the group formed by hydrogen, substituted or unsubstituted alkyl, substituted or unsubstituted cycloalkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted aryl, substituted or unsubstituted arylalkyl, substituted or unsubstituted heterocyclyl, substituted or unsubstituted heterocyclylalkyl, -COR 8 , -C(O)OR 8 , -C(O)NR 8 R 9
• n is selected from 1 , 2, 3, 4, 5, 6, 7 or 8;
• t 1,2 or 3;
• R 8 and R 9 are each independently selected from hydrogen, substituted or unsubstituted alkyl, substituted or unsubstituted cycloalkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted aryl, substituted or unsubstituted heterocyclyl, substituted or unsubstituted alkoxy, substituted or unsubstituted aryloxy, or halogen; or a pharmaceutically acceptable salt, isomer, prodrug or solvate thereof.
• R 5 and R 6 are independently selected from the group formed by hydrogen, substituted or unsubstituted alkyl, substituted or unsubstituted cycloalkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted aryl, substituted or unsubstituted arylalkyl, substituted or unsubstituted heterocyclyl, substituted or unsubstituted heterocyclylalkyl, -COR 8 , -C(O)OR 8 , -C(O)NR 8 R 9
• n is selected from 1 , 2, 3, 4, 5, 6, 7 or 8;
• t is 1 ,2 or 3;
• R 8 and R 9 are each independently selected from hydrogen, substituted or unsubstituted alkyl, substituted or unsubstituted cycloalkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted aryl, substituted or unsubstituted heterocyclyl, substituted or unsubstituted alkoxy, substituted or unsubstituted aryloxy, or halogen; or a pharmaceutically acceptable salt, isomer, prodrug or solvate thereof;
• R 1 is selected from the group formed by hydrogen, susbtituted or unsubstituted alkyl, susbtituted or unsubstituted cycloalkyl, susbtituted or unsubstituted heterocyclyl, susbtituted or unsubstituted aryl, susbtituted or unsubstituted arylalkyl, and susbtituted or unsubstituted heterocyclylalkyl;
• R 2 is selected from the group formed by hydrogen, susbtituted or unsubstituted alkyl, susbtituted or unsubstituted cycloalkyl, susbtituted or unsubstituted alkoxy, susbtituted or unsubstituted aryl, susbtituted or unsubstituted heterocyclyl, susbtituted or unsubstituted arylalkyl, and susbtituted
• R 3 and R 4 are independently selected from the group formed by hydrogen, susbtituted or unsubstituted alkyl, susbtituted or unsubstituted cycloalkyl, susbtituted or unsubstituted heterocyclyl, susbtituted or unsubstituted aryl, susbtituted or unsubstituted arylalkyl and susbtituted or unsubstituted heterocyclylalkyl or, together, R 3 and R 4 form a 3 to 6 substituted or unsubstituted member ring;
• R 5 and Re are independently selected from the group formed by hydrogen, susbtituted or unsubstituted alkyl, susbtituted or unsubstituted cycloalkyl, susbtituted or unsubstituted heterocyclyl, susbtituted or unsubstituted aryl, susbtituted or unsubstit
• R 1 is selected from Ci -6 -AIkVl, saturated or unsaturated, substituted or not substituted, branched or not branched;
• R 2 , R 3 and R 8 are independently of each other selected from H; OH, SH, NH 2 , C 1-6- Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched; Halogen; saturated or unsaturated, substituted or not substituted, branched or not branched; O — C(O)-Ci- 6 -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched; C(O)- O-C 1-6 -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched; or NH-C(O)-C 1-6 -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched;
• R 4 and R 5 are independently of each other selected from H; OH 1 SH, NH 2 , C 1- 6 -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched; Halogen; O-C 1-6 -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched;
• R 4 and R 5 taken together are -(CHR 9 ) n - forming a ring with n is selected from 1 , 2 or 3 and each R 9 independently selected from H; OH, SH, NH 2 , C 1-6 -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched; Halogen; O-C 1-6 -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched;
• R 6 and R 7 are independently of each other selected from H; OH, SH, NH 2 , C 1- 6 -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched; Halogen; or O-C 1-6 -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched;
• n selected from 0, 1 , 2, 3 or 4 and
• each R 10 independently selected from H; OH, SH, NH 2 , C 1- e ⁇ Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched; Halogen; O-C ⁇ -Alkyl, saturated or unsaturated, substituted or not substituted, branched or not branched;
• the present invention provides evidence supporting the use of sigma-1 receptor antagonists to reduce plasma levels of triglycerides. From the experimental point of view, both genetic and pharmacological approaches support the use of sigma-1 receptor antagonists to reduce plasma levels of triglycerides.
• Example 1 Genetic approach: Knockout mice deficient for the sigma-1 receptor ( ⁇ 1 " ⁇ ) show reduced plasma levels of triglycerides respect to wild type mice.
• mice from the C57BL/6J strain including wild type and knockout for the sigma-1 receptor, were used in these experiments.
• the number of animals per group ranged from 16 to 23.
• Age ranged from 9-15 weeks. All mice had free access to water ad food (standard diet for rodents SAFE A04C; Scientific Animal Food and Engineering, 91360-Villemoisson sur Orge, France; Batch 40123).
• mice were slightly anesthetized with isofluorane, blood samples were obtained from the retroorbital sinus and plasma was obtained by centrifugation. Triglyceride levels in plasma were determined using the
• mice of 8-10 weeks of age were fed for two months with high fat diet (49 % fat content; Harlan Iberica, TD97366). Treatment was administered subcutaneously, once a day, for 9 days. Treated animals received daily (for 9 days) a single dose of 50 mg/kg of BD-1063 (a sigma-1 receptor antagonist). Control animals received daily vehicle (saline). During the period of treatment, mice had free access to water and food (high fat diet). At the end of the treatment, on day 10, blood samples were obtained through intracardiac puncture and triglyceride levels were measured using the Cholestech LDX blood analyzer. Student t test was applied to determine statistical significance. The results are presented below. Values are means ⁇ standard deviation. Units are expressed as mg/100 mL
• mice 91.75 ⁇ 32.88 -Treated (50 mg/Kg BD-1063, s.c, once a day, 9 days): 56.8 ⁇ 9.41 * * p ⁇ 0.05 compared to the control wild type group

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